POQUOSON ATHLETIC ASSOCIATION

Cash or Check #
Total Amount $
Last Name
First Name
Address
City/State/Zip
Phone
Mr. Cell
Ms. Cell
Email Address
Years Experience Wrestling
Birth Date
School Attending

PARENTAL INSTRUCTION CONCERNING MEDICAL TREATMENT


Father’s Name
Father Work Phone
Mother’s Name
Mother Work Phone
Contact Person Other Than Guardian
Contact Person Phone

EMERGENCY MEDICAL INFORMATION


Doctor’s Name
Doctor Phone
Insurance Provider
Policy #
Is Your Child Presently on any medication?
If Yes, List all medications
List all sensitivities or allergies

PLEASE READ CAREFULLY AND SIGN ONLY ONE CHOICE

A. If my child needs medical attention while participating in wrestling, it is my wish that I be contacted BEFORE any medical procedures are done on my child, UNLESS immediate treatment is necessary to save my child’s life or prevent permanent injury:

A. Signature Parent/Guardian
A. Date

B. If my child needs medical attention while participating in wrestling, it is my wish that you start the treatment while efforts are being made to contact me, so that treatment is not delayed. I consent to any medical procedures that the physician believes are needed on the understanding that efforts will continue to be made to contact met. I accept responsibility for all costs related to such treatment.


B. Signature Parent/Guardian
B. Date

AFTER THE FIRST WEEK OF PRACTICE NO REFUNDS WILL BE ISSUED


I agree to return the issued singlet within a two week period following the conclusion of the season or the last date of my child’s active participation in the program, whichever comes first. If not, I will be billed $85.00.

Signature
Shirt Size

PRESS RELEASE FORM

I authorize my child’s name and/or photo to be utilized by Poquoson Athletic Association for promotional purposes.

Parent/Guardian Signature
Wrestler’s Signature

WRESTLING FAMILY INFORMATION


Wrestler Name
Grade
Parent/Guardian Name
Any/All email Address

Phone Numbers

Home
Cell
Work

POQUOSON ATHLETIC ASSOCIATION POQUOSON MIDDLE SCHOOL/YOUTH TEAMS

Our Mission Statement: Our goal is to provide a safe, fun, positive learning environment and to enable every wrestler as many opportunities as possible to further themselves in this sport as well as in life. We will teach integrity, discipline, competitiveness and fair play. This program will provide self responsibility, cooperation and dedication.

PARENT AND CHILD CODE OF CONDUCT

General Rules of Parents & Children:

1. The team will not tolerate alcohol or drug use around the practice and game areas or in any vicinity thereof.

2. No verbal abuse of a coach, child, adult, table worker, referee, or any other person affiliated with the team or with the team’s involvement.

3. There will be no fighting, hazing, harassing or bullying of anyone, anytime, anywhere. All parental concerns or complaints should be directed to the coaching staff and needs to be in writing to the Board of Directors.

PENALTIES FOR BREAKING THE RULES:

The penalty for any offense will be left to the discretion of the coaching staff or the Board of Directors. The coaching staff and Board of Directors reserve the right to remove the individual(s) from practice, tournament, or team or any other punishment applicable depending on the severity of the offence. If an individual feels that the penalty is unjust, they may appeal to the Poquoson Athletic Association Board of Directors. I have read the rules above and agree to abide by them at all times during the wrestling season.

Parent Signature
Parent Date
Wrestler Signature
Wrestler Date

The registration fee is $125.00 for
the first child & $90.00 for each additional child.
Your child will receive a free sponsors t-shirt.
please be sure to include the t-shirt size.

(YS, YM, YL, YXL, AS, AM, AL, AXL)